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Did You Know 2

Did you know that fewer and fewer doctors are accepting Medicare patients?

It is true but you may not have realized it. When your senior adult went to a new doctor they were asked three questions: name, social security number, and insurance carrier. After giving the answer to those three questions they were perhaps told, "The doctor is not accepting new patients at this time." Or "We could get you in to see the doctor but not for another six months." After your senior adult gets that response several times you and they begin to wonder, what is going on here?

Here’s what happens: This is just an example with unverified numbers but math isn’t my thing so please bear with this example.

The doctor charges you $100.00 per office visit. The doctor has contracted with Medicare to accept a payment that Medicare decides is reasonable. So Medicare decides that a reasonable fee is $70.00. That means that the Doctor is taking a $30.00 dollar loss. But don’t fear you have supplemental insurance so they will pay the doctor the remaining $30.00. WRONG. Because Medicare has determined that the office visit is only worth $70.00 under Medicare rules the doctor cannot be paid more than that even by a typical supplemental insurance carrier.

Now Medicare decides that even though they have determined the office visit is worth $70.00 they will only pay 90% or $63.00. Your supplemental insurance will then pay $7.00. Anyway you look at it the doctor is out $30.00. But you say, $30.00 so what. Well here’s what. If the doctor sees 10 patients a day (a light work load) and on each patient he loses $30.00 he is then losing $300.00 a day and if he or she works five days a week he is then losing $1500.00 a week and if he works four weeks a month--- you can see where this is going. The loss of income quickly becomes staggering.

Now to make matters worse the cost of malpractice insurance is sky rocketing at such a rate that some physicians simply can’t afford to stay in business. Well, you say, all the doctors I know are riding around in expensive cars and have $500,00.00 homes and vacation regularly in the Bahamas. Yes there are doctors that can and do afford themselves those luxuries. But let me ask you: The doctor that can and does afford these expensive things are they the doctor that is listening to your senior adult explain numerous symptoms from head to toe or is it some other doctor? My guess is it is probably some other doctor. Why? Because the doctor that is listening to your senior adult is probably an Internal Medicine doctor. That is what they do, they listen to all our little complaints and decide if we should go to a specialist (the person with the fancy car etc.) The specialist is just that, they have spent years of study and training to know about one particular area. If you go to a cardiologist, they will know about your heart, but they won’t be much help if your kidneys have a particular problem, that is someone else’s specialty.

 

So how do you get insurance to pay the doctor a reasonable fee to allow him or her to take your senior adult on as a patient? What we found in our area was get rid of Medicare. There are three or four other insurance companies in our area that accepts senior patients, no restrictions, except dialysis patients. The new insurance pays the doctor a reasonable fee and deals with Medicare. Thus the senior adult gets the doctor and service they want and the doctor gets paid enough to continue to provide those services. My suggestion is to check out other insurance companies in your area. It will take a little phone work but the effort is well worth the reward.

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